Version 5010 Enforcement Discretion Period Ends June 30

The Version 5010 enforcement discretion period ends June 30. As of July 1, all noncompliant providers and entities, including physical therapists, will be subject to enforcement action under the existing HIPAA transaction and code set enforcement process. Providers still experiencing issues regarding use of the new electronic standards in their transactions should refer to their respective vendor, clearinghouse, payer's website, or provider service department for assistance.

All HIPAA-covered entities were required to upgrade to the new ASC X12 Version 5010 (Version 5010) and NCPDP Versions D.0 and 3.0 by January 1. However, the Centers for Medicare and Medicaid Services (CMS) initiated an enforcement discretion period to give the industry additional time to upgrade to the new transaction standards.

Physical therapists who have not completed their Version 5010, D.0 or 3.0 implementation should consider the following steps:

Reach out to clearinghouses for help and take advantage of any free or low-cost software that may be available from payers.

Check with payers now to see what plans they will have in place to handle incoming claims.

Contact financial institutions to establish lines of credit to cover any temporary interruptions in claims reimbursement as a result of not being Version 5010 compliant.

For more information regarding the updated standards, visit the Versions 5010 and D.0 & 3.0 section on the CMS' website. APTA also provides resources to help physical therapists transition to HIPAA Version 5010. Go to CMS' ICD-10 website for the latest news and resources to help in preparations for the transition to ICD-10.